Incidence, Predictors and Prognostic Value of Renal Impairment in Patients Undergoing Transcatheter Aortic Valve Implantation

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Abstract Background Percutaneous balloon aortic valvuloplasty ( BAV) has only a limited role in the treatment of calcific aortic stenosis, as the results are not durable. On the other hand, transcatheter aortic valve implantation (TAVI) has shown great promise in the treatment of severe aortic stenosis in patients regarded at high risk from or inoperable by conventional surgery. Despite these benefits, a growing clinical experience with TAVI has revealed several intra- and post-procedure complications. Aim and Objectives To determine the incidence, predictors and prognostic value of renal impairment in patients undergoing trans catheter aortic valve implantation. Subjects and Methods The study was designed as a: prospective observational study. It was conducted in the period of May 2022 to May 2024 at Ain Shams University hospitals. It included 144 patients who underwent TAVI using the Medtronic self expandable valves: Evolut R valve, Boston accurate neo valve as well as balloon expandable valve Edwards Sapien 3 valve. The study included 147 patients; however 3 patients were excluded due to procedural mortality to complete the study with 144 patients. 1 patient died due to stroke, 1 patient died due to acquired hospital chest infection, and 1 patient died due to cardiac perforation. Results As regards preoperative data for the study group, fourty nine of our patients (32.03%) had adhoc revascularization. Seventy five patients had proglide vascular access (49.02%), open transfemoral vascular access while pre-existing RBBB was seen in 5 patients (13.2%). As regards aortic regurgitation, none of our patients had grade IV regurgitation. As regards fate & outcome for the study group, 5 patients (3.47%) had Complete heart block & device implantation, 1 patient (0.69%) had Improved ejection fraction, 7 patients (4.86%) had stroke, 2 patients (1.39%) had chest infection, 15 patients (10.42%) had readmission, 16 patients (11.11%) did not have improved functional capacity, 50 patients (34.72%) had improved after 1 month, 52 patients (36.11%) had improved after 3 months, 26 patients (18.06%) had improved after 6 months, and 22 patients (15.28%) had occurrence of renal impairment. By applying roc curves it was concluded that using amount of contrast more than 130ml is predictive of renal impairment occurrence after TAVI. Conclusion The present study concluded that low ejection fraction, adhoc revascularization and dye were independent predictors for renal impairment in patients undergoing transcatheter aortic valve implantation.

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